| NPI | 1457518839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203459) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT011592) |
| 207P00000X Emergency Medicine (Licence: TX N5647) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2013-11-13 |